GROWTH, NUTRITION AND DEVELOPMENT MONITORING
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Visit Date |
Age (Wks/Mths) |
Weight (Kgs) |
Height (Cms) |
Infant Feeding |
Medication Given If HIV Exposed |
TB Assessment Outcome |
Date of Next Appointment |
NVP (mls) |
CTX (mls/mg) |
M/vit |
(a) |
(b) |
(c) |
(d) |
(e) |
(f) |
(g) |
(h) |
(i) |
(j) |
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MILESTONES |
Development Milestones by Age |
Achieving Milestones? |
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LABORATORY INFORMATION |
Type of Test |
Date of Sample Collection |
Test Contextual Status |
Results |
DBS Sample Code |
Date Results Collected |
DNA PCR |
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First Antibody Test |
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Final Antibody Test |
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Early Eye Examination and Deworming |
EYE CARE ASSESSMENT |
Tetracycline Eye Ointment (TEO) Given? |
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PUPIL
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SIGHT
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SQUINT (Crossed Eyes)
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DEWORMING |
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Give once every six months to all children one year and above: If Mebendazole 500mg or Albendazole 200mg for children 1 to 2 years and 400mg for children 2 years and above
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Date of Next Visit |
Age |
Drug |
Dosage/Units |
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Clinician's Notes |
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